P1566: COMPLICATIONS ASSOCIATED WITH CENTRAL VENOUS CATHETERIZATION IN ONKOHEMATOLOGY PRACTICE
Authors: Nikolay Romanenko
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: To provide intensive chemotherapy in patients with hematology malignancies needs central vascular access. Central venous catheter (CVC) allows to perform immune, antibacterial therapy, transfusions, stem cells collection. However, this procedure may course serious complications in patients. Aims: To evaluate the incidence of complications associated with CVC in oncohematology practice. Methods: The frequency complications associated with the catheter placement procedure was studied over a period of 2003 to 2022 years in oncohematology patients (n=3161). In general procedures were performed in the right subclavian vein 2600 (82.2%), in the left subclavian v. – 552 (17.5%), and so in the right internal jugular v. 9 cases (0.3%). After CVC procedure was X-ray control or ultrasound control study. The procalcitonin test was done at temperature to discriminate bacterial from viral systemic infections and differentiate bacteremia from contaminated blood cultures. If there was suspected bloodstream infection, the microbial examination was carried out to identify bacteriological or fungal pathogen and sensitivity to antimicrobial agents. All complications were separated into immediate (associated with procedure) and delayed (associated with care of the CVC or course of the disease). Results: The complications directly associated with the technic of catheterization central vein were: 1) hematoma – in 124 cases (3.9%), 2) puncture of an artery – in 85 (2.7%), and one case of catheterization the right subclavian arteria, 3) bleeding from the catheter passage area – in 83 (2.6%), 4) clinically significant lymphorrhea – in 43 (1.4%), 5) clinically significant pneumothorax, which demanded urgent action – in 6 (0.19%) and hemoptysis – in 2 (0.06%), 7) pain, numbness, paresthesia of the upper limb were documented in 53 patients (1.6%), 8) as well as weakness, allergic Quincke’s edema, fainting or collapse associated with anesthesia were observed in 38 cases (1.2%). In addition, delayed complication associated with care of CVC or related to the course of the oncohematology disease and immunodepression were rear. Such complications as thrombophlebitis, infiltrate with thrombosis of subclavian vein were found in 83 cases (2.6%). A number of thrombotic complications were associated with bacterial infections. It was studied all documented complications associated with bloodstream infection in the form of bacteremia or fungemia. All of them were observed by using bacteriological culture. It was detected infection in 76 (2.4%) patients. Positive bacterial or fungal cultures from venous blood were detected in 94 cases; 13 blood probes contained mixed infection (2 or 3 bacterial or fungal pathogens). There were observed different microorganisms but Gram-positive pathogens prevailed – 61.8% (n=58): the most of them were Staphylococcus coagulase-negative – 50.0% (n=47), S. aureus – 8.5% (n=8), Streptococcus viridance 1.1% (n=1), Enterococcus spp. – 1.1% (n=1) and Micrococcus spp. – 1.1% (n=1). Gram-negative pathogens were found out in our patients in 29.7% (n=28) cases: Escherichia coli – 14.9% (n=14) patients, Enterobacter spp. – 9.5% (n=9), Acinetobacter spp. – 1.1% (n=1), Pseudomonas aeruginosa – 2.1% (n=2), Neisseria spp. – 2.1% (n=2). Causative agents of fungal infections were isolated for 8.5% (n=8) of patients. They included fungi of the genus Candida – 6.4% (C. albicans – 5.3% (n=5), C. crusei – 1.1% (n=1)), Rhodotorula spp. – 1.1% (n=1) and it was isolated in 1,0% (n=1) cases of Aspergillus. Summary/Conclusion: The most complications associated with CVC procedure was hematoma (3.9%), its rate depended on thrombocytopenia, disorders of coagulation hemostasis and technic of catheterization. Bloodstream infections associated with CVC were caused by gram-positive microbes in more cases (coagulase-negative Staphylococcus), rarely were caused by gram-negative (Escherichia coli). Keywords: Transfusion, Bleeding, Central venous catheter, Infection